Trial Outcomes & Findings for Dexmedetomidine Versus Midazolam for Facilitating Extubation (NCT NCT00744380)

NCT ID: NCT00744380

Last Updated: 2016-09-28

Results Overview

Recruitment status

COMPLETED

Study phase

NA

Target enrollment

23 participants

Primary outcome timeframe

Duration of ICU stay, for up to 24 weeks

Results posted on

2016-09-28

Participant Flow

Participant milestones

Participant milestones
Measure
Midazolam
Midazolam infusion of 1 mg/hour (final infusion concentration of 0.5 mg/mL) and adjusted by 1 mg/hour by the bedside nurse as needed for the desired level of sedation (Riker sedation-agitation score of 3 - 4) as other sedatives are down titrated. Daily awakenings are used. Midazolam: Midazolam infusion of 1 mg/hour (final infusion concentration of 0.5 mg/mL) and adjusted by 1 mg/hour by the bedside nurse as needed for the desired level of sedation (Riker sedation-agitation score of 3 - 4)
Dexmedetomidine
Dexmedetomidine 0.15 µg/kg per hour (final infusion concentration of 0.075 µg/kg per mL) and adjusted by 0.15 µg/kg per hour by the bedside nurse as needed for the desired level of sedation (Riker sedation-agitation score of 3 - 4)as other sedatives are down titrated. Daily awakenings are used. Dexmedetomidine: Dexmedetomidine 0.15 µg/kg per hour (final infusion concentration of 0.075 µg/kg per mL) and adjusted by 0.15 µg/kg per hour by the bedside nurse as needed for the desired level of sedation (Riker sedation-agitation score of 3 - 4)
Overall Study
STARTED
12
11
Overall Study
COMPLETED
12
11
Overall Study
NOT COMPLETED
0
0

Reasons for withdrawal

Withdrawal data not reported

Baseline Characteristics

Dexmedetomidine Versus Midazolam for Facilitating Extubation

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Midazolam
n=12 Participants
Midazolam infusion of 1 mg/hour (final infusion concentration of 0.5 mg/mL) and adjusted by 1 mg/hour by the bedside nurse as needed for the desired level of sedation (Riker sedation-agitation score of 3 - 4) as other sedatives are down titrated. Daily awakenings are used. Midazolam: Midazolam infusion of 1 mg/hour (final infusion concentration of 0.5 mg/mL) and adjusted by 1 mg/hour by the bedside nurse as needed for the desired level of sedation (Riker sedation-agitation score of 3 - 4)
Dexmedetomidine
n=11 Participants
Dexmedetomidine 0.15 µg/kg per hour (final infusion concentration of 0.075 µg/kg per mL) and adjusted by 0.15 µg/kg per hour by the bedside nurse as needed for the desired level of sedation (Riker sedation-agitation score of 3 - 4)as other sedatives are down titrated. Daily awakenings are used. Dexmedetomidine: Dexmedetomidine 0.15 µg/kg per hour (final infusion concentration of 0.075 µg/kg per mL) and adjusted by 0.15 µg/kg per hour by the bedside nurse as needed for the desired level of sedation (Riker sedation-agitation score of 3 - 4)
Total
n=23 Participants
Total of all reporting groups
Age, Continuous
57.8 years
STANDARD_DEVIATION 9.3 • n=99 Participants
58.3 years
STANDARD_DEVIATION 15.3 • n=107 Participants
58.1 years
STANDARD_DEVIATION 13.5 • n=206 Participants
Sex: Female, Male
Female
5 Participants
n=99 Participants
5 Participants
n=107 Participants
10 Participants
n=206 Participants
Sex: Female, Male
Male
7 Participants
n=99 Participants
6 Participants
n=107 Participants
13 Participants
n=206 Participants
Weight
105.2 kg
STANDARD_DEVIATION 40.9 • n=99 Participants
100.8 kg
STANDARD_DEVIATION 37.4 • n=107 Participants
103 kg
STANDARD_DEVIATION 38.5 • n=206 Participants
Acute Physiologic And Chronic Health Evaluation III Score
70.4 units on a scale
STANDARD_DEVIATION 33.5 • n=99 Participants
74.1 units on a scale
STANDARD_DEVIATION 18.2 • n=107 Participants
72.8 units on a scale
STANDARD_DEVIATION 25 • n=206 Participants
Primary Diagnosis
Respiratory failure
5 participants
n=99 Participants
5 participants
n=107 Participants
10 participants
n=206 Participants
Primary Diagnosis
Sepsis
5 participants
n=99 Participants
4 participants
n=107 Participants
9 participants
n=206 Participants
Primary Diagnosis
Other
2 participants
n=99 Participants
2 participants
n=107 Participants
4 participants
n=206 Participants
Time in ICU before qualifying
1.1 days
n=99 Participants
1.2 days
n=107 Participants
1.1 days
n=206 Participants
Time from qualifying to randomization
1 days
n=99 Participants
0.7 days
n=107 Participants
0.9 days
n=206 Participants
Baseline Sedative
Midazolam
10 participants
n=99 Participants
6 participants
n=107 Participants
16 participants
n=206 Participants
Baseline Sedative
Lorazepam
2 participants
n=99 Participants
5 participants
n=107 Participants
7 participants
n=206 Participants

PRIMARY outcome

Timeframe: Duration of ICU stay, for up to 24 weeks

Population: The analysis only includes patients successfully extubated for at least 72 hours. Eight subjects were excluded.

Outcome measures

Outcome measures
Measure
Midazolam
n=8 Participants
Midazolam infusion of 1 mg/hour (final infusion concentration of 0.5 mg/mL) and adjusted by 1 mg/hour by the bedside nurse as needed for the desired level of sedation (Riker sedation-agitation score of 3 - 4) as other sedatives are down titrated. Daily awakenings are used. Midazolam: Midazolam infusion of 1 mg/hour (final infusion concentration of 0.5 mg/mL) and adjusted by 1 mg/hour by the bedside nurse as needed for the desired level of sedation (Riker sedation-agitation score of 3 - 4)
Dexmedetomidine
n=7 Participants
Dexmedetomidine 0.15 µg/kg per hour (final infusion concentration of 0.075 µg/kg per mL) and adjusted by 0.15 µg/kg per hour by the bedside nurse as needed for the desired level of sedation (Riker sedation-agitation score of 3 - 4)as other sedatives are down titrated. Daily awakenings are used. Dexmedetomidine: Dexmedetomidine 0.15 µg/kg per hour (final infusion concentration of 0.075 µg/kg per mL) and adjusted by 0.15 µg/kg per hour by the bedside nurse as needed for the desired level of sedation (Riker sedation-agitation score of 3 - 4)
Time From Study Drug Initiation to Tracheal Extubation
2.9 days
Interval 2.0 to 4.4
3.4 days
Interval 2.6 to 14.2

SECONDARY outcome

Timeframe: Duration of ICU stay, for up to 24 weeks

Outcome measures

Outcome measures
Measure
Midazolam
n=12 Participants
Midazolam infusion of 1 mg/hour (final infusion concentration of 0.5 mg/mL) and adjusted by 1 mg/hour by the bedside nurse as needed for the desired level of sedation (Riker sedation-agitation score of 3 - 4) as other sedatives are down titrated. Daily awakenings are used. Midazolam: Midazolam infusion of 1 mg/hour (final infusion concentration of 0.5 mg/mL) and adjusted by 1 mg/hour by the bedside nurse as needed for the desired level of sedation (Riker sedation-agitation score of 3 - 4)
Dexmedetomidine
n=11 Participants
Dexmedetomidine 0.15 µg/kg per hour (final infusion concentration of 0.075 µg/kg per mL) and adjusted by 0.15 µg/kg per hour by the bedside nurse as needed for the desired level of sedation (Riker sedation-agitation score of 3 - 4)as other sedatives are down titrated. Daily awakenings are used. Dexmedetomidine: Dexmedetomidine 0.15 µg/kg per hour (final infusion concentration of 0.075 µg/kg per mL) and adjusted by 0.15 µg/kg per hour by the bedside nurse as needed for the desired level of sedation (Riker sedation-agitation score of 3 - 4)
Cumulative Doses of Conventional Sedatives and Analgesics
Open-label midazolam while on study drug
29 mg
Interval 18.8 to 48.9
65.3 mg
Interval 24.5 to 92.3
Cumulative Doses of Conventional Sedatives and Analgesics
All midazolam whil eon study drug
126.9 mg
Interval 93.2 to 608.8
65.3 mg
Interval 24.5 to 92.3
Cumulative Doses of Conventional Sedatives and Analgesics
All fentanyl while on study drug
5.4 mg
Interval 3.5 to 9.2
4.1 mg
Interval 3.0 to 14.0

SECONDARY outcome

Timeframe: Duration of ICU stay, for up to 24 weeks

The Riker sedation-agitation score (range 1-7) and PABS (range 0-10) are assessed hourly by the bedside nurse. Riker scores assess restlessness and cooperation. Riker scores of 5 - 7 indicate agitation, 3 - 4 represent adequate sedation and 1 - 2 represent excessive sedation. PABS assessments include domains of restlessness, muscle tone, vocalization, consolability, and facial expressions. PABS assessments of 0 represent no pain, 1 - 3 represent mild pain, 4 - 6 represent moderate pain, and ≥ 7 represent severe pain.

Outcome measures

Outcome measures
Measure
Midazolam
n=12 Participants
Midazolam infusion of 1 mg/hour (final infusion concentration of 0.5 mg/mL) and adjusted by 1 mg/hour by the bedside nurse as needed for the desired level of sedation (Riker sedation-agitation score of 3 - 4) as other sedatives are down titrated. Daily awakenings are used. Midazolam: Midazolam infusion of 1 mg/hour (final infusion concentration of 0.5 mg/mL) and adjusted by 1 mg/hour by the bedside nurse as needed for the desired level of sedation (Riker sedation-agitation score of 3 - 4)
Dexmedetomidine
n=11 Participants
Dexmedetomidine 0.15 µg/kg per hour (final infusion concentration of 0.075 µg/kg per mL) and adjusted by 0.15 µg/kg per hour by the bedside nurse as needed for the desired level of sedation (Riker sedation-agitation score of 3 - 4)as other sedatives are down titrated. Daily awakenings are used. Dexmedetomidine: Dexmedetomidine 0.15 µg/kg per hour (final infusion concentration of 0.075 µg/kg per mL) and adjusted by 0.15 µg/kg per hour by the bedside nurse as needed for the desired level of sedation (Riker sedation-agitation score of 3 - 4)
The Quality of Sedation (Assessed by the Riker Sedation-Agitation Score) and Analgesia (Assessed by the Pain Assessment Behavioral Score)
Riker score 3-4 while on study drug
84.1 percentage of assessments while on study
71.2 percentage of assessments while on study
The Quality of Sedation (Assessed by the Riker Sedation-Agitation Score) and Analgesia (Assessed by the Pain Assessment Behavioral Score)
Riker score 5-7 while on study drug
6.6 percentage of assessments while on study
27.1 percentage of assessments while on study
The Quality of Sedation (Assessed by the Riker Sedation-Agitation Score) and Analgesia (Assessed by the Pain Assessment Behavioral Score)
Pain score > 3 while on study drug
13.3 percentage of assessments while on study
21.4 percentage of assessments while on study
The Quality of Sedation (Assessed by the Riker Sedation-Agitation Score) and Analgesia (Assessed by the Pain Assessment Behavioral Score)
Riker score 1-2 while on study drug
5.4 percentage of assessments while on study
4.1 percentage of assessments while on study

SECONDARY outcome

Timeframe: Duration of ICU stay, up to 24 weeks

Outcome measures

Outcome measures
Measure
Midazolam
n=12 Participants
Midazolam infusion of 1 mg/hour (final infusion concentration of 0.5 mg/mL) and adjusted by 1 mg/hour by the bedside nurse as needed for the desired level of sedation (Riker sedation-agitation score of 3 - 4) as other sedatives are down titrated. Daily awakenings are used. Midazolam: Midazolam infusion of 1 mg/hour (final infusion concentration of 0.5 mg/mL) and adjusted by 1 mg/hour by the bedside nurse as needed for the desired level of sedation (Riker sedation-agitation score of 3 - 4)
Dexmedetomidine
n=11 Participants
Dexmedetomidine 0.15 µg/kg per hour (final infusion concentration of 0.075 µg/kg per mL) and adjusted by 0.15 µg/kg per hour by the bedside nurse as needed for the desired level of sedation (Riker sedation-agitation score of 3 - 4)as other sedatives are down titrated. Daily awakenings are used. Dexmedetomidine: Dexmedetomidine 0.15 µg/kg per hour (final infusion concentration of 0.075 µg/kg per mL) and adjusted by 0.15 µg/kg per hour by the bedside nurse as needed for the desired level of sedation (Riker sedation-agitation score of 3 - 4)
Sedation-related Adverse Effects
Hypotension
6 participants
10 participants
Sedation-related Adverse Effects
Bradycardia
7 participants
7 participants
Sedation-related Adverse Effects
Tachycardia
5 participants
7 participants
Sedation-related Adverse Effects
Delirium, new onset
5 participants
1 participants

SECONDARY outcome

Timeframe: Duration of hospital stay, up to 24 weeks

Population: Only subjects capable of performing the ICU-SEQ were provided the assessment. Seven subjects were excluded.

The ICU-SEQ assesses patient recall of their ICU experience. The ICU-SEQ assesses both psychological (e.g. fearfulness, anxiety) and physical (e.g. pain, difficulty breathing) perceptions of ICU patients who have received mechanical ventilation. It consists of 29 potentially stressful experiences with seven items specifically addressing the endotracheal tube. The extent that patients are bothered by each item is scored on a five point scale: 0 = "not at all," 1 = "a little bit," 2 = "moderately," 3 = "quite a bit," and 4 = "extremely." The cumulative score is an integer interpreted as interval data with higher scores indicating greater stressful experiences associated with the ICU. The minimum score is 0 and the maximum score possible is 116.

Outcome measures

Outcome measures
Measure
Midazolam
n=8 Participants
Midazolam infusion of 1 mg/hour (final infusion concentration of 0.5 mg/mL) and adjusted by 1 mg/hour by the bedside nurse as needed for the desired level of sedation (Riker sedation-agitation score of 3 - 4) as other sedatives are down titrated. Daily awakenings are used. Midazolam: Midazolam infusion of 1 mg/hour (final infusion concentration of 0.5 mg/mL) and adjusted by 1 mg/hour by the bedside nurse as needed for the desired level of sedation (Riker sedation-agitation score of 3 - 4)
Dexmedetomidine
n=8 Participants
Dexmedetomidine 0.15 µg/kg per hour (final infusion concentration of 0.075 µg/kg per mL) and adjusted by 0.15 µg/kg per hour by the bedside nurse as needed for the desired level of sedation (Riker sedation-agitation score of 3 - 4)as other sedatives are down titrated. Daily awakenings are used. Dexmedetomidine: Dexmedetomidine 0.15 µg/kg per hour (final infusion concentration of 0.075 µg/kg per mL) and adjusted by 0.15 µg/kg per hour by the bedside nurse as needed for the desired level of sedation (Riker sedation-agitation score of 3 - 4)
ICU Experiences by Administering ICU Stressful Experiences Questionnaire (ICU-SEQ)
8.5 units on a scale
Interval 0.0 to 29.0
18.5 units on a scale
Interval 0.0 to 29.0

SECONDARY outcome

Timeframe: Duration of ICU stay, up to 24 weeks

Outcome measures

Outcome measures
Measure
Midazolam
n=12 Participants
Midazolam infusion of 1 mg/hour (final infusion concentration of 0.5 mg/mL) and adjusted by 1 mg/hour by the bedside nurse as needed for the desired level of sedation (Riker sedation-agitation score of 3 - 4) as other sedatives are down titrated. Daily awakenings are used. Midazolam: Midazolam infusion of 1 mg/hour (final infusion concentration of 0.5 mg/mL) and adjusted by 1 mg/hour by the bedside nurse as needed for the desired level of sedation (Riker sedation-agitation score of 3 - 4)
Dexmedetomidine
n=11 Participants
Dexmedetomidine 0.15 µg/kg per hour (final infusion concentration of 0.075 µg/kg per mL) and adjusted by 0.15 µg/kg per hour by the bedside nurse as needed for the desired level of sedation (Riker sedation-agitation score of 3 - 4)as other sedatives are down titrated. Daily awakenings are used. Dexmedetomidine: Dexmedetomidine 0.15 µg/kg per hour (final infusion concentration of 0.075 µg/kg per mL) and adjusted by 0.15 µg/kg per hour by the bedside nurse as needed for the desired level of sedation (Riker sedation-agitation score of 3 - 4)
Duration of Study Drug Administration
3 days
Interval 0.8 to 5.1
3.5 days
Interval 2.0 to 4.9

SECONDARY outcome

Timeframe: Duration of hospital stay, up to 24 weeks

Population: Only subjects capable of performing the IES-R were provided the assessment. Seven subjects were excluded.

The IES-R evaluates subjective distress caused by traumatic events and assesses manifestations of post-traumatic stress disorder (PTSD) or acute stress disorder. It is not diagnostic but possesses excellent reliability and validity for manifestations of PTSD. The IES-R has three subscales (eight items on intrusion, eight items on avoidance, and six items on hyperarousal). Each item is scored on a four point scale: 0 = "not at all," 1 = "a little bit," 2 = "moderately often," 3 = "quite a bit," and 4 = "extremely often." The total score of each subscale may be averaged and a cumulative score of 30 is indicative of the presence of PTSD. The maximum score for each subscale is 32 for intrusion, 32 for avoidance, and 24 for hyperarousal. The minimum cumulative score is 0 and the maximum cumulative score possible is 88.

Outcome measures

Outcome measures
Measure
Midazolam
n=8 Participants
Midazolam infusion of 1 mg/hour (final infusion concentration of 0.5 mg/mL) and adjusted by 1 mg/hour by the bedside nurse as needed for the desired level of sedation (Riker sedation-agitation score of 3 - 4) as other sedatives are down titrated. Daily awakenings are used. Midazolam: Midazolam infusion of 1 mg/hour (final infusion concentration of 0.5 mg/mL) and adjusted by 1 mg/hour by the bedside nurse as needed for the desired level of sedation (Riker sedation-agitation score of 3 - 4)
Dexmedetomidine
n=8 Participants
Dexmedetomidine 0.15 µg/kg per hour (final infusion concentration of 0.075 µg/kg per mL) and adjusted by 0.15 µg/kg per hour by the bedside nurse as needed for the desired level of sedation (Riker sedation-agitation score of 3 - 4)as other sedatives are down titrated. Daily awakenings are used. Dexmedetomidine: Dexmedetomidine 0.15 µg/kg per hour (final infusion concentration of 0.075 µg/kg per mL) and adjusted by 0.15 µg/kg per hour by the bedside nurse as needed for the desired level of sedation (Riker sedation-agitation score of 3 - 4)
Manifestations of Acute Stress Disorder by Impact of Event Scale - Revised (IES-R)
13 units on a scale
Standard Deviation 12
36 units on a scale
Standard Deviation 12

SECONDARY outcome

Timeframe: Duration of hospital stay, up to 24 weeks

Population: Only subjects capable of performing the HADS were provided the assessment. Seven subjects were excluded.

The HADS consists of 14 questions, seven for anxiety and seven for depression. Each item is scored from 0 to 3, with a cut-off cumulative score of 11 for both subscales indicative of anxiety or depression. This scoring tool has been used for 30 years, possesses excellent reliability and validity, and avoids reliance conditions that are also common somatic symptoms of illness such fatigue, insomnia, and hypersomnia. The maximum score for each subscale is 21 with a maximum possible cumulative score of 42. The minimum score for each subscale is 0. The minimum cumulative score is 0

Outcome measures

Outcome measures
Measure
Midazolam
n=8 Participants
Midazolam infusion of 1 mg/hour (final infusion concentration of 0.5 mg/mL) and adjusted by 1 mg/hour by the bedside nurse as needed for the desired level of sedation (Riker sedation-agitation score of 3 - 4) as other sedatives are down titrated. Daily awakenings are used. Midazolam: Midazolam infusion of 1 mg/hour (final infusion concentration of 0.5 mg/mL) and adjusted by 1 mg/hour by the bedside nurse as needed for the desired level of sedation (Riker sedation-agitation score of 3 - 4)
Dexmedetomidine
n=8 Participants
Dexmedetomidine 0.15 µg/kg per hour (final infusion concentration of 0.075 µg/kg per mL) and adjusted by 0.15 µg/kg per hour by the bedside nurse as needed for the desired level of sedation (Riker sedation-agitation score of 3 - 4)as other sedatives are down titrated. Daily awakenings are used. Dexmedetomidine: Dexmedetomidine 0.15 µg/kg per hour (final infusion concentration of 0.075 µg/kg per mL) and adjusted by 0.15 µg/kg per hour by the bedside nurse as needed for the desired level of sedation (Riker sedation-agitation score of 3 - 4)
Hospital Anxiety and Depression Scale (HADS) Score
Anxiety
3 units on a scale
Standard Deviation 3.1
6 units on a scale
Standard Deviation 7.6
Hospital Anxiety and Depression Scale (HADS) Score
Depression
6 units on a scale
Standard Deviation 6.7
4 units on a scale
Standard Deviation 5.3

Adverse Events

Midazolam

Serious events: 0 serious events
Other events: 12 other events
Deaths: 0 deaths

Dexmedetomidine

Serious events: 1 serious events
Other events: 11 other events
Deaths: 0 deaths

Serious adverse events

Serious adverse events
Measure
Midazolam
n=12 participants at risk
Midazolam infusion of 1 mg/hour (final infusion concentration of 0.5 mg/mL) and adjusted by 1 mg/hour by the bedside nurse as needed for the desired level of sedation (Riker sedation-agitation score of 3 - 4) as other sedatives are down titrated. Daily awakenings are used. Midazolam: Midazolam infusion of 1 mg/hour (final infusion concentration of 0.5 mg/mL) and adjusted by 1 mg/hour by the bedside nurse as needed for the desired level of sedation (Riker sedation-agitation score of 3 - 4)
Dexmedetomidine
n=11 participants at risk
Dexmedetomidine 0.15 µg/kg per hour (final infusion concentration of 0.075 µg/kg per mL) and adjusted by 0.15 µg/kg per hour by the bedside nurse as needed for the desired level of sedation (Riker sedation-agitation score of 3 - 4)as other sedatives are down titrated. Daily awakenings are used. Dexmedetomidine: Dexmedetomidine 0.15 µg/kg per hour (final infusion concentration of 0.075 µg/kg per mL) and adjusted by 0.15 µg/kg per hour by the bedside nurse as needed for the desired level of sedation (Riker sedation-agitation score of 3 - 4)
Nervous system disorders
Acute Neurologic Encephalopathy
0.00%
0/12
9.1%
1/11 • Number of events 1

Other adverse events

Other adverse events
Measure
Midazolam
n=12 participants at risk
Midazolam infusion of 1 mg/hour (final infusion concentration of 0.5 mg/mL) and adjusted by 1 mg/hour by the bedside nurse as needed for the desired level of sedation (Riker sedation-agitation score of 3 - 4) as other sedatives are down titrated. Daily awakenings are used. Midazolam: Midazolam infusion of 1 mg/hour (final infusion concentration of 0.5 mg/mL) and adjusted by 1 mg/hour by the bedside nurse as needed for the desired level of sedation (Riker sedation-agitation score of 3 - 4)
Dexmedetomidine
n=11 participants at risk
Dexmedetomidine 0.15 µg/kg per hour (final infusion concentration of 0.075 µg/kg per mL) and adjusted by 0.15 µg/kg per hour by the bedside nurse as needed for the desired level of sedation (Riker sedation-agitation score of 3 - 4)as other sedatives are down titrated. Daily awakenings are used. Dexmedetomidine: Dexmedetomidine 0.15 µg/kg per hour (final infusion concentration of 0.075 µg/kg per mL) and adjusted by 0.15 µg/kg per hour by the bedside nurse as needed for the desired level of sedation (Riker sedation-agitation score of 3 - 4)
Cardiac disorders
Hypotension
50.0%
6/12 • Number of events 6
90.9%
10/11 • Number of events 10
Cardiac disorders
Bradycardia
58.3%
7/12 • Number of events 7
63.6%
7/11 • Number of events 7
Cardiac disorders
Tachycardia
41.7%
5/12 • Number of events 5
63.6%
7/11 • Number of events 7
Nervous system disorders
Delirium, new onset
41.7%
5/12 • Number of events 5
45.5%
5/11 • Number of events 5

Additional Information

Robert MacLaren

University of Colorado

Phone: 303 724-2622

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place